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Medicare: Facts and Convictions

By Gary Gutting June 22, 2011 9:05 pmJune 22, 2011 9:05 pm

The Stone is a forum for contemporary philosophers and other thinkers on issues both timely and timeless.

The Stone is featuring occasional posts by Gary Gutting, a professor of philosophy at the University of Notre Dame, that apply critical thinking to information and events that have appeared in the news.

We tend to view our political arguments as instruments of intellectual compulsion, forcing opponents to recognize the truth. This seldom happens. On major issues, politicians typically don’t change positions because they see the light but because they feel the heat.

It’s tempting to think that those who persist in disagreeing with us are intellectually or morally inferior — either fools or knaves — and sometimes this is true. Here, however, I want to explore another way of understanding intractable political disagreements, taking as an example my recent effort to get a handle on the current debate over Medicare.

I began in May by reading Paul Ryan’s speech on his debt-reduction plan. He rightly started with the essential first step in any helpful argument: with premises that he and his opponents agree on. Both sides accept that there must be drastic reductions in the level of our federal debt and that such reductions require serious constraints on federal spending for the Medicare program.
But, I thought, Ryan faltered in formulating the two main options in the current debate, his plan and President Obama’s. “Our plan,” he said, “is to give seniors the power to deny business to inefficient providers. Their plan is to give government the power to deny care to seniors.” Here Ryan identifies his proposal with what he claims as its principal benefit and Obama’s with what Ryan claims is its principal defect. A fair formulation requires a simple description of what Ryan and Obama propose to do, separate from alleged drawbacks of their doing it.

It took me a while to sort through the rhetoric on both sides to arrive at reasonably neutral descriptions of what Ryan and Obama propose. Simplifying quite a bit, I came up with the following: Ryan wants to control costs by introducing market mechanisms into the Medicare system, whereas Obama wants to control costs by having government agencies exercise various sorts of control over medical practices.

Putting it this way, it became clear to me that everyone agreed that either plan, if implemented, would significantly reduce government spending on medical care. The debate was about each plan’s further consequences. Roughly, critics of Ryan’s plan claim that it will require seniors to pay far too much for their medical care, while critics of Obama’s plan claim that it will keep seniors from receiving needed medical care.

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At this point, it seemed that the debate was over empirical questions: What would be the effects of each of the policies? In principle, such questions should be answerable by objective economic analysis. So I began reading Congressional Budget Office reports, articles in The Economist, and opinions by columnists from Ross Douthat to Ezra Klein. My expectation was that I would find a stalemate, with strong arguments on both sides off-setting one another. But as it turned out, my judgment was that the empirical probabilities supported Obama over Ryan. Of course others as or more qualified than I have concluded otherwise.

More importantly, I realized that the relevant economic facts were soft (relatively malleable). Even if they pointed in Obama’s direction, they did not decisively refute Ryan. Economists with strong (relatively inflexible) convictions about the privileged role of markets and the dangers of government regulation could develop alternative interpretations of the facts that supported Ryan’s position. Such strong convictions would be irrelevant if they were ungrounded prejudices. But there is clearly a higher level of economic discussion on which the free-market economists as well as their opponents have developed what they see as a powerful historical and even philosophical case for their convictions. Paul Ryan was, perhaps, gesturing to this level of conviction when he said, “This is not a budget; this is a cause.”

The moral of my story is that understanding and effectively taking part in a debate requires awareness of the level at which we and our opponents are operating at any given point. When we are arguing from the facts, there is a reasonable possibility of convincing one another. When we find ourselves arguing about convictions, the ordinary point-counterpoint of political debate becomes ineffective. We can and should argue about convictions, but this can seldom be done fruitfully in the context of specific policy disputes. Once we’ve pushed the debate on Medicare or any other policy matter to the point where convictions become the sole basis of disagreement, it is time to vote.

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The Stone features the writing of contemporary philosophers and other thinkers on issues both timely and timeless. The series moderator is Simon Critchley. He teaches philosophy at The New School for Social Research in New York. To contact the editors of The Stone, send an e-mail to opinionator@nytimes.com. Please include “The Stone” in the subject field.